Eighty-war-·< Id ,<:;;1111 dicln 'l understand what ;i ll 1hc ft1ss was al out: pe, pie I ';ming nut of thei r car w in lows. s,· rt.a1ning ;1t him 1111d honking their horns, poli ~c t.iffi<.'L·rs :1sking all sons of 4ut:s1ion:. :1{,<:using l1im or'~iriving t.li ··· wro ng cli rt!Cli on in rll.';h hour tr, ffi . \Vl w didn·r th t·\' leavl' him :il <"Jn , •;- He w,1s· doing just 1·ine. ·

Della, a 65-yc:ir-old former p.~ychc logist re(;c ntly di:•, ,nnsed with ,1\lz lwimcr' ::; di:;e .;:1se, didn' t alway.· u1,clerstand 1r:1 ffi c signs. but her d()ctor h: 1ci s;:i id she could still d1ive a: I< ng as she suyed in her own rL:as.'iuringly ramili:ir neighbo rhood. One day she risked :1 trip clnwnrown. Lost, confused a nd di:; :,rient cl. Della rnisintc..:rprcted a red light driving straighr in10 ;i bU:iV intersection. - ·

Lud;il y, S:1m and Della wuen·r hurt, and 1hey didn't hurt anvone else. But e:1d1 time an Alzhcimc;r•; p;llient get.~ b\~hind the whc:.t:I, thl' devas1ati11g ·vmptom.~ of the di.st::ase --- chi efl v me1111'.>ry loss, impaired judgment,·, nd confu. i1 n - become putl'.nlially deadly. NO\V .:1 new stu dv :-it the Sebo,. I 0f Ml:"d icinc wi ll :malv1.c'h(.)\,' Ali'.­lleimer's ~1ffects drivi,-,g :1bility.

Study is first of its kind .. J)e<.iple ,-vich i\lthi."i lll<:-:r"s diS\~<Js1.·

w h,:i con tinue 10 dri v"<: mav ri.•k tlkir o vn1 s:1f' tY :ind t!ur n f oth,crs ;1 .~ w,• 11 ," ,-;;iy;:, Linch I lunt, :in occupatio n;il I lwr:1 pi.-1 :I! the Universirv. ··\\/it h <J ll f

popubtinn growing okk:r and <:-;lS<:.s ,f' A.!zlwimc~r·s cJi. ·(::1:Sc <'.:>n th· ri.···. it's

e sential that we find ;1n ()bjE:clive met.hod for c.le.ciding whether pati nr: c:1 1,1 Cr)ntirnw to drive o r if their driving .-h ul I he' n: .strict ··d ,;r sropp d.'

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Hunt, supeivisor of dull commu­nity services and director of the driving progr.am at the School of Medicine's Irene Walter Johnson Institute of Rehabilitation, is investigating the effec:.1.s of senile dementia of the Alzheimer's type (SDAT) on driving ability. Her study is the first to evaluate on-the-road perfom1ance of drivers with SDAT.

Hunt hopes the study, funded by the Missouri Alzheimer's Disease Task Force, will contribute to the develop­ment of mandatory state driving evaluations for the older population. ·n1e project should also establish

uiddin · rd· kling h n , DAT pali rus h uld A L ff the r<xtd.

"'T'he pr bl m f incell · uaUy impair d older dult b dri i of m· j r im nan , yel tht!rc' · virru U n lnfi rmau n availabl • that addr this issue, nor do state laws provide a unified approach toward testing the skills of aging drivers,'' says neurolo­gist John C. Morris, M.D., a physician with the Washington University Alzheimer's Disease Research Center. "Hunt's study will provide much needed data to help determirw rational and effective strategies for dealing with the serious implications of demented c.lriv<:rs. ''

More accidents reported Ahout 12 percent of the l '.S.

population - more than 16 million 1woplc -- is ni:iv, 6"i or older. An t·-~tirnatecl 'i to iO pcr.::enl ot that group su trcis frorn Alzheinwr •.~ disease. an i1 11. urahk· ncurologic disorder 1h;.H is tl1<.· rno,,1 uJlll llH ,11 c;lli:-..:· of illH:llcctu:li !ll tp:llrnh·nt ;11u1H,_!.: 11:c c·ldcd\ 111 tlH :1t.· \t p ) \ 1.'.1r<.., , ... ~\pt: 1~·, prnfci..L 1i1v i't·t( L-'Jll.: .~.~1. · ;_.-l \;1:._~:·i, .ln": ::,:..~v;_1 r•~ ;}f

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that drivers in even the earliest stages of SDAT pose a threat to community safety. A five-year pilot study, pub­lished last year in the Annals of Neurology, found that nearly half of 30 drivers with SDAT had been involved in at least one car crash, whereas only three of 30 control subjects had been involved in a crash during the same period.

A survey published in the Journal of the American Geriatrics Society revealed that 21 of72 drivers with SOAT had had at least one accident since the onset of dementia, with an additional eight reported hy family members to have caused accidents.

Aging it.o;elf, even without the complications caused by Alzheimer's disease, affects driving: vision dims, hearing dulls, reflexes and reaction tirne slow down, an<l arthritis may limit range of motion, making it hard for the older driver to look over his or her shoulder.

"Because of these changes, older people often have trouble processing a lot of differt"nt information at once, and that's what driving is all about," s:iys Hunt. "Statistics show that the elderly have most of their auro acci­dents when changing lanes, when lllaking left-hand turns. and when hacking up. probably because: there :lr(: so many steps to consic.kr during Lhesc rnaneuv.;r;,."

Other frcqni:nt driving errors of ttw dderly include failur(' lo vield the rigllr , ,f ,~ :1y ~11HI n1isintcrpre1:11.ion or di-..rq!,,i!"d !)r ,trt.'( ' l .',igm, .

rrcedoin vs. safety \Jn\,;r \\.'lii<.k- uJ.-;!t('~ ,in . .:· tfll'

fi:: tdtn:,.; ~ ,l\t·~t_' l \! ~i;.· .. Hl•.':1Lll . k·~Hh f(H.

the 1,~.' ~1.!..~L 1 ' i \).-:) ;- · -, t ., nd i h~.~ --..,_·,'<ind '. t :thn.:..: . J.; ... · =: dt·-- u1 Li,r.1 !()l" il1 1 )-..,,.•

Two-part fflldy planned Hunt's yeir-lonl-l -..Lud~ will fcxu:­

on --10 patients with qm·stiornhk and, rrnld '-iDAT and \\ ill crnt~hr nf iwo . p,llb: ~I prL'-dri\111g ,·v,tlu.1{1(,n nm- · du.-r,:cl hy an OL\·up.:rional tl1cr;1pbt. ;incl .111 in-nir :iss,.-•;-,1,1,·n1 " 1nducl1:d "'} 1 ,!1:vi.ng in.,trnc1,1r t'\·ni!iu! !" \York

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the driver's ability to stop, make turns, maintain proper speed, change lanes, signal, pass, park, back up, and enter and exit highways, will take an hour and cover a IO-mile route. Both parts of the evaluation were developed by the Irene Walter Johnson Institute of Rehabilitation as part of its driving program, which was established in 1984 to teach disabled patients com­pensatory driving techniques.

Family members or other car­egivers will also be part of the study. "It's important to question family members and enlist their cooperation," says Hunt. "Many times, those closest to S T p t it::.nl · d n't want to al'Cept tha th p ti nt ma need to stop drivin, thu ' ming less mobile and more d ~ nden1 than he~ r · ."

T nt , < ntr ,1 ·ubj 1. matched to the~ T pnricnts fi >r g •. sex, and length of driving experience. will also be tested. The SDAT patients will be recnlitcd from Washington University's Memory and Aging Project, a long­term .study of intellectual function in older adults.

Although all states have regula­tions governing the issuance of licenses, only 14 offer specific guide­lines requiring older drivers to take lin:nse-renc\,;al tests. Hunt hopes that results of thl..' ·wal-ihington Universitv study. he.sicks contril>uting to the · f<mnul:ition of a reliable tool for ~1ssess111g the driving skill.~ of Alz­hciJHL'J ·s p.H icnts. will 11ndt:r,;,·on.: tlw 11,:nl fnr wid(:'~p1·l:ad kgi-..latirn1

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